南方医科大学学报

南方医科大学学报 ›› 2005, Vol. 25 ›› Issue (11): 1454-1455.

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肾移植术后新尿路梗阻的临床处理(附16例报告)

聂海波1, 何恢绪1, 李逊2, 邓志雄1, 朱云松1, 胡卫列1, 吕军1, 邱晓佛1, 张小明1   

  1. 1. 广州军区广州总医院泌尿外科, 广东, 广州, 510010;
    2. 广州医学院附一院微创外科中心, 广东, 广州, 510261
  • 出版日期:2005-11-20 发布日期:2005-11-20
  • 基金资助:
    收稿日期:2005-3-29。
    作者简介:聂海波(1965-),男,副主任,副教授,现为南方医科大学在读博士,电话:020-36653336

Management of urinary obstruction following renal transplantation:report of 16 cases

NIE Hai-bo1, HE Hui-xu1, LI Xun2, DENG Zhi-xiong1, ZHU Yun-song1, HU Wei-lie1, LU Jun1, QIU Xiao-fu1, ZHANG Xiao-ming1   

  1. 1. 广州军区广州总医院泌尿外科, 广东, 广州, 510010;
    2. 广州医学院附一院微创外科中心, 广东, 广州, 510261
  • Online:2005-11-20 Published:2005-11-20

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摘要： 目的 探讨肾移植术后新尿路梗阻的诊断及处理对策。方法 回顾总结1983-2004年我院485例肾移植病人中的16例移植后新尿路梗阻患者,其中移植肾输尿管结石5例,采用输尿管镜下气压弹道碎石术;输尿管膀胱吻合口狭窄6例,3例开放手术,3例经皮移植肾穿刺高压气囊扩张后放置双J管;移植肾肾盂输尿管连接部狭窄梗阻2例,采用输尿管镜下气囊扩张,放置记忆合金支架;输尿管排斥全程坏死1例,采用带血管蒂回肠段代移植坏死输尿管;移植肾周感染、输尿管末段坏死2例,采用移植肾近端新鲜存活输尿管与自体输尿管端侧吻合。结果 16例肾移植术后新尿路梗阻患者中1例开放手术大出血切除移植肾。其余各例患者经腔镜处理及开放手术均成功挽救移植肾功能。再次手术后随访0.5～3年,血肌酐90～150μmol/L,B超未见移植肾扩张积水加重。结论 新上尿路梗阻是肾移植术后常见亦是较为棘手的外科并发症,处理宜遵循先腔内后开放的思路针对引起梗阻的具体原因部位采用相应的术式。

Abstract: Objective To explore the diagnosis and treatment of urinary obstruction involving the transplanted kidney. Methods A retrospective analysis was performed in 16 cases of urinary obstruction involving the transplanted kidney, including 5 cases of ureteral calculi, 6 vesicoureteral anastomotic stricture, 2 pyeloureteral junction stricture after transplantation, 1 ureter necrosis due to graft rejection, and 2 infection surrounding the renal graft and ureter end necrosis. Results Only one patient had the renal graft removed due to massive hemorrhage in an open surgery for correction of urinary obstruction, and the renal function of the graft was preserved in all the other cases after endoscopic or open surgeries. In the follow-up for 0.5 to 3 years after the second surgery, serum creatinine of the patients were maintained within the range of 90-150 μmol/L, without further renal enlargement or exacerbation of renal retention shown by B-mode ultrasonography. Conclusions Urinary obstruction after renal transplantation is a difficult surgical complication, which can be managed by endoscopic or open surgeries depending on the causes of the obstruction.

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